Form 2 SBIR e-learning Data collection tool

National Institute of Environmental Health Sciences Worker Training Program

Small Business Innovation Research (SBIR) E-Learning for HAZMAT and Emergency Response Data Collection Tool

OMB # 0925-0348 Expiration Date: 07/31/2022

Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch; 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0348). Do not return the completed form to this address.

COLLECTION: Survey of Participants in the NIEHS Worker Training Program’s SBIR E-Learning for HAZMAT and Emergency Response grants – prior, current, and future.

PURPOSE: The NIEHS Worker Training Program is seeking to gather feedback on the successes of the Worker Training Program’s Small Business Innovation Research (SBIR) E-Learning for HAZMAT and Emergency Response grants. Your valuable input will help the Worker Training Program evaluate and communicate the impact of the SBIR grants and help inform future efforts.

Contact information is optional but is requested for the purpose of writing grant activity highlights or success stories.

1. Name (optional):

2. Company(optional):

3. Email(optional):

4. How has your SBIR e-Learning grant worked to improve the use of technology in training and education to workers performing duties in a hazardous environment?

5. We are interested in whether your SBIR e-Learning grant has led to the development of intellectual property. Have you applied for one or more patents? Yes or No.

   1. If Yes, provide the patent application number:

6. Have you licensed your e-Learning technology innovation(s)? Yes or No

7. Have you spun-off or started a new company based on your e-Learning technology innovation(s)? Yes or No.

   1. If Yes, please provide the name of the company:

8. Did your SBIR e-Learning technology innovation(s) result in the sale of your company? Yes or No

9. Are there additional successes of your e-Learning technology innovation(s) that you would like to provide?

10. Did or do you collaborate with other WTP grantees to implement your SBIR grant? Yes or No.

    1. If yes, describe the collaboration.

11. What have been your challenges during the application or implementation process of your SBIR grant?

12. What has helped you overcome those challenges?